Provider Demographics
NPI:1790258192
Name:GURDIEL, REYNA TIFFANY FIGUEROA (BSN-RN)
Entity Type:Individual
Prefix:
First Name:REYNA TIFFANY
Middle Name:FIGUEROA
Last Name:GURDIEL
Suffix:
Gender:F
Credentials:BSN-RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3817 SW HALL BLVD
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-2049
Mailing Address - Country:US
Mailing Address - Phone:503-608-7717
Mailing Address - Fax:503-608-7718
Practice Address - Street 1:3817 SW HALL BLVD
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2049
Practice Address - Country:US
Practice Address - Phone:503-608-7717
Practice Address - Fax:503-608-7718
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-08
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201509519RN163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health